The voices of children and young people during COVID-19: A critical review of methods.

AIM: Critically review research methods used to elicit children and young people's views and experiences in the first year of COVID-19, using an ethical and child rights lens. METHODS: A systematic search of peer-reviewed literature on children and young people's perspectives and experiences of COVID-19. LEGEND (Let Evidence Guide Every New Decision) tools were applied to assess the quality of included studies. The critical review methodology addressed four ethical parameters: (1) Duty of care; (2) Children and young people's consent; (3) Communication of findings; and (4) Reflexivity. RESULTS: Two phases of searches identified 8131 studies; 27 studies were included for final analysis, representing 43,877 children and young people's views. Most studies were from high-income countries. Three major themes emerged: (a) Whose voices are heard; (b) How are children and young people heard; and (c) How do researchers engage in reflexivity and ethical practice? Online surveys of children and young people from middle-class backgrounds dominated the research during COVID-19. Three studies actively involved children and young people in the research process; two documented a rights-based framework. There was limited attention paid to some ethical issues, particularly the lack of inclusion of children and young people in research processes. CONCLUSION: There are equity gaps in accessing the experiences of children and young people from disadvantaged settings. Most children and young people were not involved in shaping research methods by soliciting their voices.

Tuberculosis infection in under-2-year-old refugees: Should we be screening? A systematic review and meta-regression analysis.

AIM: Refugees are at increased risk of tuberculosis infection due to time spent in crowded camps, decreased nutrition and originating from countries whose own tuberculosis control systems may have been disturbed. In Australia, tuberculosis is screened for in for all refugees aged 11-34 years old and in those aged 2-10 years arriving from high-incidence countries. Our aims were to determine if refugee children aged under 2 years of age should also be screened. METHODS: A systematic literature review and meta-regression was carried out on studies in refugee children under 18 years old, involving screening for tuberculosis (active or latent tuberculosis infection (LTBI)). Studies were extracted from the last 10 years from a range of bibliographic databases using the search terms 'tuberculosis', 'children', 'screening' and 'refugee', which tested for tuberculosis using the tuberculin skin test (TST) or QuantiFERON-Gold (Interferon Gamma Release Assay (IGRA)). RESULTS: Of the 15 included studies, prevalence of LTBI in < 2-year-olds was 5% using IGRA and 15% using TST (P < 0.05). Prevalence increased with age (odds ratio 1.12; 95% confidence interval: 1.06-1.17) cumulatively and decreased where IGRA was used for screening compared to TST (odds ratio 0.38; 95% confidence interval: 0.25-0.58). Prevalence of LTBI did not differ between general versus clinic refugee cohorts. CONCLUSIONS: Refugees are a particularly vulnerable group in their susceptibility to tuberculosis, and LTBI management is a critical part of tuberculosis disease control due to the lifetime risk of developing active tuberculosis. A prevalence of 5-15% for LTBI in the under 2 years age group would support them being included in screening programmes.

Optimising refugee children's health/wellbeing in preparation for primary and secondary school: a qualitative inquiry.

BACKGROUND: Children from refugee backgrounds are less likely to access appropriate health and social care than non-refugee children. Our aim was to identify refugee children's health/wellbeing strengths and needs, and the barriers and enablers to accessing services while preparing for primary and secondary school, in a low socio-economic multicultural community in Australia. METHOD: Ten focus groups were facilitated with Arabic-speaking refugee parents of children aged 2-5 years (n = 11) or in first year secondary school (n = 22); refugee adolescents starting high school (n = 16); and key service providers to refugee families (n = 27). Vignettes about a healthy child and a child with difficulties guided the discussions. Data was thematically analysed and feedback sought from the community via the World Café method. RESULTS: Personal resilience and strong family systems were identified as strengths. Mental health was identified as a complex primary need; and whilst refugees were aware of available services, there were issues in knowing how to access them. Opportunities for play/socialisation were recognised as unmet adolescent needs. Adults spoke of a need to support integration of "old" and "new" cultural values. Parents identified community as facilitating health knowledge transfer for new arrivals; whilst stakeholders saw this as a barrier when systems change. Most parents had not heard of early childhood services, and reported difficulty accessing child healthcare. Preschooler parents identified the family "GP" as the main source of health support; whilst parents of adolescents valued their child's school. Health communication in written (not spoken) English was a significant roadblock. Differences in refugee family and service provider perceptions were also evident. CONCLUSIONS: Refugee families face challenges to accessing services, but also have strengths that enable them to optimise their children's wellbeing. Culturally-tailored models of care embedded within GP services and school systems may assist improved healthcare for refugee families.

The adverse childhood experiences checklist: Can it serve as a clinical and quality indicator?

AIM: There is strong evidence that adverse childhood experiences (ACE) are associated with poor short-, medium- and long-term health outcomes. In South Western Sydney, we trialled a modified ACE checklist in community paediatric clinics. Our aim was to design the best version of the ACE checklist for routine clinical use to serve as both a clinical and quality indicator. METHODS: We trialled two versions of the modified ACE checklist based on a pre-existing tool in child development (CD) and vulnerable child (VC) clinics over a 6-month period in 2012 (V1) and 7-month period in 2017 (V2). We analysed clinical and demographic data and correlated with ACE scores. We asked clinicians about the use of the ACE checklist and modified the checklist based on clinicians' recommendations. RESULTS: In phase 1, V1 was trialled in CD clinics only; 77 children were assessed, of whom 38 children (49%) had ACE score of ≥1, and 8 (10%) had a score of ≥4. In phase 2, of 279 children assessed, 178 (64%) had ACE ≥1, and 78 (28%) had ACE ≥4. In both phases, clinicians found the checklist simple to use and helpful in identifying especially vulnerable children. CONCLUSIONS: The ACE checklist helps clinicians and managers identify the burden of exposure to trauma, violence and abuse of children attending paediatric clinics, both to facilitate intervention and aid service development. This version of the ACE checklist has the potential to be used across a variety of populations and settings as a clinical and quality indicator.

Eating soup with nails of pig: thematic synthesis of the qualitative literature on cultural practices and beliefs influencing perinatal nutrition in low and middle income countries.

BACKGROUND: The perinatal period, i.e. pregnancy, childbirth and early infancy, is a significant transition period where the biological and the social strongly intersect. In low and middle-income countries the disease burden arising from the perinatal period, is still substantial. The perinatal period is also a crucial window of opportunity for reducing undernutrition and its long term adverse effects. METHODS: We explored qualitative research conducted in low resource settings around the perinatal continuum over the past two decades, with a particular focus on the 'cultural' realm, to identify common themes influencing maternal and infant nutrition. We systematically searched electronic databases from 1990 to 2014, including MEDLINE, EMBASE, PsycINFO, Scopus and Cumulative Index to Nursing and Allied Health Literature, using relevant search terms including traditional beliefs, practices, pregnancy, childbirth, developing countries etc. Adapted Consolidated Criteria for Reporting Qualitative Health Research and Critical Appraisal Skills Programme criteria were used to determine quality of studies. We synthesised the literature thematically, enabled by NVivo 10 software. RESULTS: Most studies showed cultural support for breastfeeding, although most traditional societies delayed breastfeeding due to colostrum being considered 'dirty'. A range of restrictive practices through pregnancy and the post- partum period were revealed in Asia, Latin America and Africa. There was a strong cultural understanding of the healing power of everyday foods. A wide range of good foods and bad foods continued to have currency through the perinatal continuum, with little consensus between groups of what was beneficial versus harmful. Cross-cutting themes that emerged were 1) the role of the woman/mother/wife as strong and good; 2) poverty restricting women's nutrition choices; 3) change being constant, but the direction of change unpredictable. CONCLUSIONS: A rich and diverse repertoire of cultural practices and beliefs influenced perinatal nutrition. Results from this synthesis should influence public health policymakers and practitioners, to tailor contextually specific, culturally responsive perinatal nutrition interventions to optimise health and wellbeing of mother-infant dyads. Ideally these interventions should build on culturally sanctioned life affirming behaviours such as breastfeeding, promoting post-partum rest and recovery, while modifying the potentially harmful aspects of other cultural practices in the perinatal period.

"We have to ask and only then do": Unpacking agency and autonomy in women's reproductive health in urban India.

The limited autonomy and agency of women in developing countries is recognized as a key barrier to improving their reproductive health. Using an existing perinatal cohort in urban South India, we interviewed 36 women who had recently been through childbirth, and we carried out observations of family life and clinic encounters. Critical domains involved in women's agency and autonomy were women's participation in employment and group action and their mobility. Household decision making was considered a joint rather than individual responsibility. We call for a more nuanced understanding of these domains and their relationship to women's reproductive health, particularly for urban populations.

Did Inequalities in Mothers' and Children's Health and Well-Being in Japan Increase through the Pandemic? Evidence from Nationwide Surveys and Routinely Collected Data.

Marginalised families faced significant challenges during the COVID-19 pandemic. This study explores inequalities in Japanese mothers' and children's health and well-being and family economic stability before and during the pandemic. Data sources were as follows: nationwide surveys in 2019 and 2021 of families with children using medical institutions across Japan; infant mortality and adolescent suicide rates between 2018 and 2021 from publicly available sources. Outcomes by poor and non-poor families were compared for 2019 and 2021 using simple descriptive statistics. Poor mothers' part-time working increased from 41% to 61% and regular employment was reduced by two thirds. The well-being of poor mothers worsened from 39% to 55%. Employment opportunities and well-being did not change for non-poor mothers. School subsidies among poor families increased from 23% to 55%. The infant mortality rate (IMR) among unemployed families increased significantly from 12.9/1000 to 18.2/1000 between 2018 and 2021 compared with a decreasing overall IMR from 1.9/1000 to 1.7/1000. Suicide rates in 10-19-year-olds increased over the same period although no socio-economic indicators were available. Inequalities in mothers' and children's health and well-being indicators and family economics increased between 2019 to 2021 in Japan. This study cannot attribute causes but suggests a possible role of the pandemic.

Clinical Pathways for the Identification and Referral for Social Needs: A Systematic Review.

CONTEXT: Recognition of the importance of the social determinants of child health has prompted increased interest in clinical pathways that identify and refer for social needs. OBJECTIVE: The aim of this systematic review was to determine the effectiveness of interventions that identify and refer for social needs for families with children aged 0 to 18 years attending outpatient community and ambulatory healthcare services. DATA SOURCES: We searched the following databases: Medline, Embase, PsychINFO, CINAHL, Emcare, EBMR. STUDY SELECTION: Studies were included if children and their families underwent a process of identification and referral for social needs in outpatient community and ambulatory healthcare services. DATA EXTRACTION: Initial searches identified 5490 titles, from which 18 studies (73 707 families and children) were finally retained. RESULTS: Intervention pathways were grouped into 3 categories based on whether identification and referral for social needs was conducted with only targeted community resources, a navigator, or with clinician training. The majority of studies reported positive outcomes; with an increase in social needs identification, an increase in referrals following identification, or a reduction in social needs. Child health outcome results were inconsistent. LIMITATIONS: The search terms used may have provided bias toward countries in which these terms are in use. The heterogeneity of outcome measures between included studies meant a meta-analysis was not possible. CONCLUSIONS: Despite evidence that clinical pathways for children and families help reduce social needs, evidence for improvements in child health is insufficient. Further studies from diverse settings are needed to inform clinical practice to optimize child health outcomes.

Changing landscape of paediatric refugee health in South Western Sydney, Australia: a retrospective observational study.

OBJECTIVES: To examine the changing health needs of refugee children and young people (CYP) entering Australia, in relation to key government policy changes. STUDY DESIGN: Retrospective analysis of health service use data over 11 years. SETTING: Paediatric refugee clinics in South Western Sydney (SWS), the Australian region with the largest annual resettlement of refugees. PARTICIPANTS: Refugee CYP (≤25 years) attending the SWS paediatric refugee clinics for their first visit between 2009 and 2019. MEASURES: Clinician defined health conditions categorised as communicable and non-communicable disease (NCD). RESULTS: Data were analysed for 359 CYP, mean age 9.3 years; 212 male (59.1%). Most CYP (n=331, 92.2%) had health problems identified; 292 (81.3%) had ≥1 NCD and 24 (6.7%) had ≥1 communicable disease. The most frequent individual NCDs were dental disease (n=128, 35.7%) and vitamin D deficiency (n=72, 20.1%). Trend analysis showed increased odds of identifying an NCD from 2013 onwards (crude OR 1.77, 95% CI 1.06 to 2.96). Neurodevelopmental problems, especially Global Developmental Delay (n=31, 8.6%), emerged as more prevalent issues in the latter half of the decade. There were significantly increased odds of identifying a neurodevelopmental problem in 2016-2019, especially in 2016-2017 (adjusted OR 2.93, 95% CI 1.34 to 6.40). Key policy changes during this period included acceptance of refugees with disabilities from 2012, additional Australian Humanitarian Programme intake from the Eastern Mediterranean region and mandatory offshore processing for those seeking asylum by boat from 2013. In response to the changing needs, local health services adopted nurse-led primary healthcare screening, early childhood services, youth and disability clinics. CONCLUSIONS: Refugee CYP in Australia are presenting with a growing burden of NCDs, with neurodevelopmental problems contributing. Government policy changes affect the sociodemographics of resettled populations, influencing health profiles. Paediatric refugee health services need to be responsive to the changing needs of these populations to optimise well-being.

Language outcomes at 4 years of linguistically diverse children born very preterm: an Australian retrospective single-centre study.

BACKGROUND: Very preterm children are at increased risk of language delays. Concerns have been raised about the utility of standardised English language tools to diagnose language delay in linguistically diverse children. Our study investigated the incidence of language delay at 4 years in linguistically diverse very preterm children. METHODS: Very preterm children born in South Western Sydney, Australia, between 2012 and 2016, were assessed with the Clinical Evaluation of Language Fundamentals Preschool-2 (CELF-P2) tool at 4 years of age. We sought to determine the incidence of language delay in this cohort using language scores from the CELF-P2 assessment tool, and explore potential predictors associated with language delay. RESULTS: One hundred and sixty very preterm children attended the 4-year assessment out of the included 270 long-term survivors. At 4 years, 76 (52%) very preterm children had language delay diagnosed using the CELF-P2 assessment tool. Children who preferred a language other than English had lower average core language scores on the CELF-P2 assessment tool (75.1±14.4) compared with children that preferred English (86.5±17.9); p=0.002. Very preterm children growing up in households that preferenced a language other than English and those who were born from multiple births had higher odds of language delay at 4 years (AOR 10.30 (95% CI 2.82 to 38.28); p<0.001 and AOR 2.93 (95% CI 1.20 to 7.14); p=0.018, respectively). Assessing these children using an English language tool may have affected language scores at 4 years. CONCLUSIONS: In this metropolitan setting, very preterm children from linguistically diverse backgrounds were found to be vulnerable to language delays at 4 years. Further large-scale studies evaluating the language outcomes of linguistically diverse preterm children with more culturally appropriate tools are warranted. We question the utility of standardised English language tools to assess language outcomes of linguistically diverse populations.

Offshore detention: cross-sectional analysis of the health of children and young people seeking asylum in Australia.

OBJECTIVE: To describe the health and well-being of children and young people (CYP) seeking asylum subjected to Australia's immigration policy of indefinite mandatory detention on Nauru. DESIGN: Cross-sectional analysis of a cohort of CYP seeking asylum. SETTING: Australian paediatric clinicians from 10 health services completed detailed health assessments around the time of transfer from Nauru, mostly to Australia. PARTICIPANTS: Sixty-two CYP who were ≤18 years on entry into offshore immigration detention on Nauru between 2013 and 2019. Mean age at health assessment was 9 years. MAIN MEASURES: Health outcomes were categorised as physical, mental or neurodevelopmental concerns/conditions. Risk and protective factor data were collected using the adverse childhood experiences and refugee-specific adverse childhood experiences tools. RESULTS: Over half of the CYP (n=32, 52%) were held on Nauru for ≥4 years. The vast majority of CYP had physical health (n=55, 89%) and mental health (n=49, 79%) concerns including self-harm or suicidal ideation/attempt (n=28, 45%). Mental health concerns were more likely in CYP who were school-aged (p=0.001), had been held on Nauru for ≥1 year (p=0.01); originated from the Eastern Mediterranean region (p<0.05); witnessed trauma (p<0.05) or had exposure to ≥4 refugee-specific adverse childhood experiences (p<0.05). Neurodevelopmental concerns were seen in eight children (13%). CONCLUSIONS: This study highlights the almost universal physical and mental health difficulties in a sample of CYP who experienced forced migration and were subjected to Australia's offshore immigration detention policy. Immigration detention in recipient countries, a known adverse childhood experience, may contribute to or exacerbate harmful outcomes in CYP seeking asylum.

Feasibility of linking universal child and family healthcare and financial counselling: findings from the Australian Healthier Wealthier Families (HWF) mixed-methods study.

OBJECTIVES: 'Healthier Wealthier Families' (HWF) seeks to reduce financial hardship in the early years by embedding a referral pathway between Australia's universal child and family health (CFH) services and financial counselling. This pilot study investigated the feasibility and short-term impacts of HWF, adapted from a successful Scottish initiative. METHODS: Setting: CFH services in five sites across two states, coinciding with the COVID-19 pandemic. PARTICIPANTS: Caregivers of children aged 0-5 years experiencing financial hardship (study-designed screen). DESIGN: Mixed methods. With limited progress using a randomised trial (RCT) design in sites 1-3 (March 2020-November 2021), qualitative interviews with service providers identified implementation barriers including stigma, lack of knowledge of financial counselling, low financial literacy, research burden and pandemic disruption. This informed a simplified RCT protocol (site 4) and direct referral model (no randomisation, pre-post evaluation, site 5) (June 2021-May 2022). INTERVENTION: financial counselling; comparator: usual care (sites 1-4). Feasibility measures: proportions of caregivers screened, enrolled, followed up and who accessed financial counselling. Impact measures: finances (quantitative) and other (qualitative) to 6 months post-enrolment. RESULTS: 355/434 caregivers completed the screen (60%-100% across sites). In RCT sites (1-4), 79/365 (19%-41%) reported hardship but less than one-quarter enrolled. In site 5, n=66/69 (96%) caregivers reported hardship and 44/66 (67%) engaged with financial counselling; common issues were utility debts (73%), and obtaining entitlements (43%) or material aid/emergency relief (27%). Per family, financial counselling increased income from government entitlements by an average $A6504 annually plus $A784 from concessions, grants, brokerage and debt waivers. Caregivers described benefits (qualitative) including reduced stress, practical help, increased knowledge and empowerment. CONCLUSIONS: Financial hardship screening via CFH was acceptable to caregivers, direct referral was feasible, but individual randomisation was infeasible. Larger-scale implementation will require careful, staged adaptations where CFH populations and the intervention are well matched and low burden evaluation. TRIAL REGISTRATION NUMBER: ACTRN12620000154909.

Cultural issues in child maltreatment.

AIMS: Waves of immigration from the latter half of the 20th century have changed the cultural and ethnic mix of major regions of the world. Dynamic multicultural societies now are a reality across the Western world. The relationship and influence of these diverse cultures to the understanding and identification of child abuse and neglect is challenging and complex. Health professionals working with children from culturally and linguistically diverse groups often find themselves with the challenge of exploring and resolving the tension between definitions of harm in child protection practice and various cultural and child-rearing practices. In this paper, we set out ways of thinking about the influence of culture when approaching and dealing with the suspicion of child maltreatment. METHODS: We will explore how culture shapes the experiences of childhood, child-rearing practices, and identify common barriers in working with children and families from culturally diverse backgrounds when presenting with child maltreatment. We will use case examples from Europe and Australia to illustrate the real life challenges of working in the area of child maltreatment across cultures. We will review the scientific literature exploring the nexus between culture and child maltreatment, identifying the gaps in the literature and highlight areas for future research. RESULTS: We suggest a model for dealing with cultural issues in child maltreatment that is culturally competent and respectful. CONCLUSIONS: The model for cultural competency in child health and child protective services incorporates four domains for advocacy and action - individual, professional, organisational and systemic.

Identifying vulnerable children's stress levels and coping measures during COVID-19 pandemic in Japan: a mixed method study.

BACKGROUND: The COVID-19 pandemic has disproportionately affected vulnerable children and youth. In Japan, despite evidence that the paediatric age group holds a lower risk of infection than the older population, there was a nationwide closure of schools as an early public health measure. Acknowledging that school closures brought heightened psychological and physical stress among Japanese children, we aimed to explore vulnerable children's experiences of the COVID-19 pandemic in Japan, focusing on socially disadvantaged subset of the population. METHODS: We used an adapted version of the 'Perceived Stress Scale for Children', with additional free-text space, delivered online to children attending three non-profit organisations which provide support for this group of vulnerable persons and families experiencing social disadvantage. Simple descriptive analysis was undertaken on the quantitative data; we used thematic and content analysis for the qualitative data. RESULTS: Thirty-six children participated in the online survey, mean age was 11.3 years, majority (61%) were male. The mean overall stress score (score distribution width: 0-39) was 14.8, with no difference in score distribution by age or gender. Free-text responses obtained revealed a range of stressors and protective factors. Schooling, COVID-19 fears, family tension and pandemic measures were sources of stress; family-in particular, the support of the mother-food, friendship and recreation were sources of comfort. While most responses indicated positive coping mechanisms, some displayed maladaptive behaviours. CONCLUSIONS: The children in this cohort had high mean stress scores overall. Responses indicated that they were acutely reactive to COVID-19 as well as pandemic public health measures, and that missing schooling and contact with friends exacerbated their stress. Family was a source of strength as well as stress. A tailored public health response to COVID-19 needs to take into account the concerns voiced by vulnerable child populations be based on equity and child rights.

Exploring children's knowledge of COVID-19 and stress levels associated with the pandemic in Nigeria: a mixed-method study.

BACKGROUND: Children have been relatively spared from the direct effects of COVID-19 globally, but there are significant concerns about indirect effects on the most vulnerable children's well-being. Nigeria is the largest African nation, but little is known about children's experience of the COVID-19 pandemic. Our aims were to determine children's knowledge of COVID-19 and their mental health responses to the pandemic. METHODS: Children aged 6-17 years living in Calabar, Nigeria, were surveyed using a combination of online data collection assisted by parents and on-site data collection at schools. Parents filled out sociodemographic details, while children answered questions about COVID-19 knowledge and preventive measures. An adapted version of the 'Perceived Stress Scale for Children' was used to assess stress with additional free text space for expression of views and experiences of COVID-19. RESULTS: A total of 265 children completed questionnaires, mean age was 12.5 years, 52.1% were girls. All children knew about the virus and over two-thirds (67.8%) had good knowledge of COVID-19 transmission. Children identified television (60.8%), parents (44.2%) and social media (32.8%), as main sources of COVID-19 information. The overall mean stress score among the children was 20.47. Children mentioned the following as stressors: fear of the COVID-19 disease, effect of pandemic restrictions on schooling and social interactions as well as home/family tensions. Parental love and support were overwhelmingly reported as strengths. CONCLUSIONS: Nigerian children in this study had good knowledge and understanding of the COVID-19 pandemic and preventive measures to counter the virus. Children had high stress levels and expressed pandemic-related concerns but parental love and support were mitigating factors. Government and child health service providers need to tailor health and support services in response to children's needs and concerns.

Utility of screening for adverse childhood experiences (ACE) in children and young people attending clinical and healthcare settings: a systematic review.

OBJECTIVE: To examine and synthesise the literature on adverse childhood experience (ACE) screening in clinical and healthcare settings servicing children (0-11) and young people (12-25). DESIGN: A systematic review of literature was undertaken. DATA SOURCE: PsycInfo, Web of Science, Embase, PubMed and CINAHL were searched through June 2021. Additional searches were also undertaken. ELIGIBILITY CRITERIA: English language studies were included if they reported results of an ACE tool being used in a clinical or healthcare setting, participants were aged between 0 and 25 years and the ACE tool was completed by children/young people or by parents/caregivers/clinicians on behalf of the child/young person. Studies assessing clinicians' views on ACE screening in children/young people attending health settings were also included. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed for risk of bias using the Mixed Methods Appraisal Tool. Results were synthesised qualitatively. RESULTS: Initial searches identified 5231 articles, of which 36 were included in the final review. Findings showed that the most commonly used tool for assessing ACE was the ACE questionnaire; administering ACE tools was found to be feasible and acceptable; there were limited studies looking at the utility, feasibility and acceptability of assessing for ACE in First Nations people; and while four studies provided information on actions taken following ACE screening, no follow-up data were collected to determine whether participants accessed services and/or the impact of accessing services. CONCLUSION: As the evidence stands, widespread ACE screening is not recommended for routine clinical use. More research is needed on how and what specific ACE to screen for and the impact of screening on well-being. PROSPERO REGISTRATION NUMBER: University of York Centre for Reviews and Dissemination (CRD42021260420).

Connecting Healthcare with Income Maximisation Services: A Systematic Review on the Health, Wellbeing and Financial Impacts for Families with Young Children.

Financial counselling and income-maximisation services have the potential to reduce financial hardship and its associated burdens on health and wellbeing in High Income Countries. However, referrals to financial counselling services are not systematically integrated into existing health service platforms, thus limiting our ability to identify and link families who might be experiencing financial hardship. Review evidence on this is scarce. The purpose of this study is to review "healthcare-income maximisation" models of care in high-income countries for families of children aged between 0 and 5 years experiencing financial difficulties, and their impacts on family finances and the health and wellbeing of parent(s)/caregiver(s) or children. A systematic review of the MEDLINE, EMBase, PsycInfo, CINAHL, ProQuest, Family & Society Studies Worldwide, Cochrane Library, and Informit Online databases was conducted according to the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) statement. A total of six studies (five unique samples) met inclusion criteria, which reported a total of 11,603 families exposed to a healthcare-income maximisation model. An average annual gain per person of £1661 and £1919 was reported in two studies reporting one Scottish before-after study, whereby health visitors/midwives referred 4805 clients to money advice services. In another UK before-after study, financial counsellors were attached to urban primary healthcare centres and reported an average annual gain per person of £1058. The randomized controlled trial included in the review reported no evidence of impacts on financial or non-financial outcomes, or maternal health outcomes, but did observe small to moderate effects on child health and well-being. Small to moderate benefits were seen in areas relating to child health, preschool education, parenting, child abuse, and early behavioral adjustment. There was a high level of bias in most studies, and insufficient evidence to evaluate the effectiveness of healthcare-income maximisation models of care. Rigorous (RCT-level) studies with clear evaluations are needed to assess efficacy and effectiveness.

Study protocol for a real-world evaluation of an integrated child and family health hub for migrant and refugee women.

INTRODUCTION: Continuity of child and family healthcare is vital for optimal child health and development for developmentally vulnerable children. Migrant and refugee communities are often at-risk of poor health outcomes, facing barriers to health service attendance including cultural, language, limited health literacy, discrimination and unmet psychosocial needs. 'Integrated health-social care hubs' are physical hubs where health and social services are co-located, with shared referral pathways and care navigation. AIM: Our study will evaluate the impact, implementation and cost-benefit of the First 2000 Days Care Connect (FDCC) integrated hub model for pregnant migrant and refugee women and their infants. MATERIALS AND METHODS: This study has three components. Component 1 is a non-randomised controlled trial to compare the FDCC model of care with usual care. This trial will allocate eligible women to intervention and control groups based on their proximity to the Hub sites. Outcome measures include: the proportion of children attending child and family health (CFH) nurse services and completing their CFH checks to 12 months of age; improved surveillance of growth and development in children up to 12 months, post partum; improved breastfeeding rates; reduced emergency department presentations; and improved maternal well-being. These will be measured using linked medical record data and surveys. Component 2 will involve a mixed-method implementation evaluation to clarify how and why FDCC was implemented within the sites to inform future roll-out. Component 3 is a within-trial economic evaluation from a healthcare perspective to assess the cost-effectiveness of the Hubs relative to usual care and the implementation costs if Hubs were scaled and replicated. ETHICS AND DISSEMINATION: Ethical approval was granted by the South Eastern Sydney Local Health District Human Research Ethics Committee in July 2021 (Project ID: 020/ETH03295). Results will be submitted for publication in peer-reviewed journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER: ACTRN12621001088831.

Screening and social prescribing in healthcare and social services to address housing issues among children and families: a systematic review.

OBJECTIVES: Housing is a social determinant of health that impacts the health and well-being of children and families. Screening and referral to address social determinants of health in clinical and social service settings has been proposed to support families with housing problems. This study aims to identify housing screening questions asked of families in healthcare and social services, determine validated screening tools and extract information about recommendations for action after screening for housing issues. METHODS: The electronic databases MEDLINE, PsycINFO, EMBASE, Ovid Emcare, Scopus and CINAHL were searched from 2009 to 2021. Inclusion criteria were peer-reviewed literature that included questions about housing being asked of children or young people aged 0-18 years and their families accessing any healthcare or social service. We extracted data on the housing questions asked, source of housing questions, validity and descriptions of actions to address housing issues. RESULTS: Forty-nine peer-reviewed papers met the inclusion criteria. The housing questions in social screening tools vary widely. There are no standard housing-related questions that clinical and social service providers ask families. Fourteen screening tools were validated. An action was embedded as part of social screening activities in 27 of 42 studies. Actions for identified housing problems included provision of a community-based or clinic-based resource guide, and social prescribing included referral to a social worker, care coordinator or care navigation service, community health worker, social service agency, referral to a housing and child welfare demonstration project or provided intensive case management and wraparound services. CONCLUSION: This review provides a catalogue of housing questions that can be asked of families in the clinical and/or social service setting, and potential subsequent actions.

Addressing the well-being of Aboriginal children in out-of-home care: are we there yet?

AIM: Children in out-of-home care (OOHC) have well-documented health and developmental needs. In Australia, Aboriginal children have significantly worse health outcomes than non-Aboriginal children. We wanted to identify the health and well-being of Aboriginal children entering OOHC, placed with an Aboriginal organisation, who accessed a specialised multidisciplinary clinic in south-western Sydney. We wanted to identify children entering care who were doing well and who improved in care. We also wanted to identify enablers and barriers to care. METHODS: We analysed records of the first 100 children attending the OOHC clinic in south-western Sydney. Measures included clinical outcomes and recommendations at first and subsequent visits. Descriptive statistics were calculated using SPSS 16.0 for Windows (SPSS Inc., Chicago, IL, USA). Key stakeholders from the relevant agencies were interviewed about enablers and barriers to care by independent evaluators. RESULTS: A significant proportion of children had health needs identified including speech delay (54%), under-immunisation (50%), behaviour problems (45%), hearing problems (44%), visual problems (35%) and dental problems (36%). Sixteen per cent of the children were doing well at first visit; a third improved in care, and a third remained stable. Significant differences were identified in health and educational needs between the under-5 year olds and the 5-13 year olds. Key barriers identified were systemic issues and lack of resources for intervention. CONCLUSIONS: Children attending this clinic had similar rates of problems identified as other studies. School-age children appear to have significant additional health needs. Targeted developmentally and culturally appropriate interventions need to be provided to address the identified barriers to care.